MP71-05 COST-EFFECTIVENESS MARKOV MODEL COMPARING HIGH- AND LOW-ENERGY TRANSURETHRAL MICROWAVE THERAPY FOR BENIGN PROSTATIC HYPERPLASIA

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2014MP71-05 COST-EFFECTIVENESS MARKOV MODEL COMPARING HIGH- AND LOW-ENERGY TRANSURETHRAL MICROWAVE THERAPY FOR BENIGN PROSTATIC HYPERPLASIA James C. Ulchaker and MD FACS Melissa MartinsonMS PhD James C. UlchakerJames C. Ulchaker More articles by this author and Melissa MartinsonMelissa Martinson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral microwave therapy (TUMT) can be grouped into low-energy (LE-TUMT) and high-energy (HE-TUMT) categories based on both microwave wattage and intraprostatic temperatures. Historical retreatment rates, meta-analyses and disease management guidelines point to greater durability and clinical effectiveness of HE-TUMT, but cost effectiveness has not previously been compared. We created an economic model comparing cost-effectiveness of LE-TUMT and HE-TUMT. METHODS We constructed a Markov model similar to published models on Benign Prostatic Hyperplasia (BPH) procedures using published outcomes and 2013 Medicare costs. American Urological Association Symptom scores (AUASS), adverse events (AEs), and retreatment rates at annual intervals were obtained from the literature. Costs to treat AEs and retreatment rates were included in calculating total costs. Quality Adjusted Life Years (QALYs) were calculated from preference weights from the literature for health states of BPH, successfully treated BPH, treated BPH with erectile dysfunction, and treated BPH with urinary incontinence, over the time spent in each. RESULTS The table below shows total costs, mean AUASS, and QALYs at 2 and 4 years. Using an incremental cost-effectiveness ratio (ICER) at 4 years, HE-TUMT dominated LE-TUMT where HE-TUMT was more effective and less expensive over time. HE-TUMT saved $3,026 at 4 years and achieved 3 points of greater symptom score improvement, saving $868 per incremental point reduction. CONCLUSIONS Due to higher retreatment rates, LE-TUMT is more expensive than HE-TUMT at 2 and 4 years and less effective. While HE-TUMT dominates LE-TUMT in cost effectiveness in this model, additional studies should compare these costs to BPH medication and surgical therapies. While Medicare costs are clearly lower for drugs on day 1 and higher for surgery on day 1, this type of model has the potential to help identify cost effective options across treatment modalities over the course of time. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e791 Advertisement Copyright & Permissions© 2014MetricsAuthor Information James C. Ulchaker More articles by this author Melissa Martinson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...